Biomedical Signal Processing and Control 56 (2020) 101695 Contents lists available at ScienceDirect Biomedical Signal Processing and Control journal homepage: www.elsevier.com/locate/bspc Improving the management of medical imaging by using robust and secure dual watermarking M. Cedillo-Hernandez a,∗ , A. Cedillo-Hernandez b , M. Nakano-Miyatake a , H. Perez-Meana a a Instituto Politecnico Nacional SEPI ESIME Culhuacan, Avenida Santa Ana 951, San Francisco Culhuacan, Culhuacan CTM V, C.P. 04260, Coyoacan, Ciudad de Mexico, Mexico b Universidad Politecnica Metropolitana de Hidalgo, Ex Hacienda San Javier, Boulevard Acceso a Tolcayuca 1009, 43860, Tolcayuca, Hidalgo, Mexico a r t i c l e i n f o Article history: Received 28 June 2019 Received in revised form 9 September 2019 Accepted 5 October 2019 Keywords: Digital watermarking Image processing Information security DICOM imaging Authentication Detachment detection a b s t r a c t Nowadays, the management of medical imaging could be affected by several issues related to informa- tion security. Among others, a critical issue is related to information authentication. A promissory way to solve this issue is the use of digital watermarking to improve the management of medical imaging. In this paper, we propose a robust and secure medical image watermarking method that involves invisi- ble and zero watermarking techniques that provide a proper link between clinical information, medical image, and patient identity. Concealing an encoded and encrypted watermark signal in the frequency domain of the medical image, the invisible watermarking component avoids the detachment between the medical images and their corresponding electronic patient record. Based on a modified spread spec- trum technique, the response of the invisible watermarking detector and the watermark information, the zero watermarking stage authenticates in a confidential form the identity of the patient. Experimental results show the effectiveness of the proposed method in terms of transparency, security, reliability, and robustness of the watermark against several image processing operations. A comparison with state of the art proposals with similar purposes to the proposed method is also provided. The presented work may find applications in the secure and effective management of medical imaging. © 2019 Elsevier Ltd. All rights reserved. 1. Introduction Due to its relevance in clinical diagnosis, treatment, research, and other commercial and non-commercial applications of public and private organizations; medical information is highly valuable and delicate by nature. In recent years the fast and significant advances in terms of information technologies (IT) have generated a large number of changes to conceptual and application-level into the paradigm of medical information management. The modern and integrated healthcare systems such as Hospital Information System (HIS) and Picture Archiving and Communication System (PACS) among others; provides easy access, manipulation, and dis- tribution of medical data [1–3]. There are several reasons for the interchange of medical information, e.g. telemedicine applications where we found teleconsultation, telediagnosis, and telesurgery with aims of e-learning of the medical staff. On the other hand, ∗ Corresponding author. E-mail addresses: mcedilloh@ipn.mx (M. Cedillo-Hernandez), acedillo@upmh.edu.mx (A. Cedillo-Hernandez). the Electronic Patient Record (EPR) has replaced the ineffective paradigm of the medical record in hardcopy format. Usually, EPR contains diagnosis reports, medical images, and biomedical signals, among other information, however, also could contain medi- cal record such as demographic data, results of medical testing, treatments, medical prescriptions, among others, which are by defi- nition highly confidential [3,4]. These advances in the technology of medical information management have brought as a consequence new risks by the inappropriate use of the medical information, given the facility with which the digital data could be manipulated and distributed. In a medical image context, these have unique features and requirements that moreover of the ethics and legal aspects, should be preserved to define the allowed operations on the medical infor- mation so that it does not cause a degradation level on the image that can generate a wrong medical diagnosis [5]. Thus, it is imper- ative to improve its security. In this way moreover of security improvement, is needs the design of suitable medical image storage and distribution systems, with controlled and restricted access to medical imaging, preserving unaltered the requirements of authen- tication, integrity, and confidentiality of medical data, with aims of https://doi.org/10.1016/j.bspc.2019.101695 1746-8094/© 2019 Elsevier Ltd. All rights reserved.